HB 2370 requires health insurance plans in the state to cover self-administered hormonal contraceptives (like birth control pills or patches) for up to 90 days (or 180 days for generic versions) starting January 1, 2026, and for up to one year starting January 1, 2027. The coverage must include both generic and brand-name options and cannot impose higher deductibles or co-payments than other standard health services. This bill specifically excludes emergency contraception and medications used to terminate pregnancy from its requirements. It directly affects health insurance plans and individuals using these contraceptive methods by expanding coverage duration and cost-sharing rules.
HB 1942 requires Missouri health insurance plans sold or renewed on or after January 1, 2027, to cover one annual whole-body skin exam for suspicious lesions without any cost-sharing (like copays or deductibles). This applies to all standard health benefit plans issued in Missouri, directly affecting insured Missourians seeking preventive skin cancer screenings. The bill mandates coverage using standard medical codes for the exam and prohibits insurers from charging patients for this specific service. It excludes supplemental policies like Medicare supplements and short-term plans from this requirement.
HB 2596 modifies rules for multi-employer self-insured health plans, which are arrangements offering health benefits to employees of two or more employers (or self-employed individuals) without full insurance backing. The bill requires these plans to maintain a minimum financial safety net - either three times their average monthly premium, $600,000, or two times their risk-based capital amount - depending on their experience. This directly affects staff leasing companies and multi-employer health plans that operate without a fully insured insurer. The changes aim to ensure these plans have sufficient funds to cover future claims.
HB 1675 limits when health insurance companies (health carriers) can require doctors and hospitals (health care providers) to get prior authorization for medical services. Specifically, insurers cannot demand prior approval unless they approved less than 90% of similar requests from that provider in the previous six-month period (either January-June or July-December). The bill requires insurers to notify providers within 25 days after each period, provide appeal options, and maintain an online portal showing all authorization decisions. It applies to most health plans but excludes Medicaid managed care organizations and providers who haven’t participated in a plan for a full six-month period. The law does not change what services are covered or allow providers to exceed their licensed scope.
HB 1944 regulates how Missouri health insurers pay for anesthesia services and handle claim adjustments. It prohibits insurers from setting time limits on anesthesia payments or excluding all anesthesia time from calculations. The bill bans automated systems (including AI) for reducing payments on claims, requiring human physician reviews instead, and mandates clear documentation of downcoding decisions with 180-day appeal timelines. This directly affects anesthesia providers, insurers, and state health programs like MO HealthNet.
SB 1327 requires health insurance plans and pharmacy benefit managers to count all medication costs (when a generic drug isn't available) toward an enrollee's annual out-of-pocket maximum. It prohibits plans from adjusting cost-sharing requirements based on whether assistance programs exist for non-generic drugs. This directly affects individuals enrolled in health benefit plans who take medications without generic alternatives. The law ensures these medication costs fully count toward coverage limits, providing clearer cost transparency for enrollees.
HB 2309, titled the "End Organ Harvesting Act of 2026," prohibits Missouri health insurance plans and Medicaid programs (including MO HealthNet and Medicaid managed care) from covering organ transplants or post-transplant care under two specific conditions: if the transplant occurs in China, or if the organ was obtained through sale or donation originating in China. The bill directly affects health insurers, patients seeking transplants involving China, and healthcare providers billing these insurers. Key provisions require health carriers to deny coverage for transplants meeting either of these China-related criteria. This is a policy change restricting insurance coverage for specific transplant scenarios, not a procedural measure.
HB 2465 amends Missouri's definition of "eligible employee" under the Small Employer Health Insurance Availability Act. It specifies that an eligible employee must work a full-time schedule of 30+ hours per week, including sole proprietors, partners, and independent contractors covered under a small employer's health plan. The change explicitly excludes part-time, temporary, and substitute workers from eligibility for small employer health insurance programs. This adjustment affects small employers (typically those with fewer than 50 employees) and their workers seeking coverage under this state insurance program.
HB 2570 requires health insurers and health benefit plans (including MO HealthNet and Medicaid managed care) to pay for anesthesia services based on defined "anesthesia time" units without imposing time limits or restricting how that time is calculated. The bill prohibits insurers from setting arbitrary time caps on anesthesia payment or excluding all anesthesia time when determining reimbursement. It specifically affects anesthesia providers (like anesthesiologists and nurse anesthetists) by mandating payment based on standardized time units and prevailing medical billing standards. The law passed as an emergency measure to ensure timely payment for these medically necessary services.
HB 1820 creates a state registration system for doulas to enable health insurance reimbursement of their services in Missouri. The bill requires the state Department of Health to establish application criteria, review registration applications, approve or deny registrations, and maintain a public registry of approved doulas. It specifies that doulas providing non-medical support (not medical care) can register to seek reimbursement, though unregistered doulas may still practice. The department must consult community organizations like the Missouri Community Doula Council when setting registration rules. This bill does not mandate insurance coverage but provides the framework for insurers to reimburse registered doulas.
